Prediction of Survival by Pretreatment Health-Related Quality-Of-Life Scores in a Prospective Cohort of Patients With Head and Neck Squamous Cell Carcinoma

JAMA Otolaryngol Head Neck Surg. 2013 Jan;139(1):14-20. doi: 10.1001/jamaoto.2013.1056.


Objective: To evaluate the association between pretreatment health-related quality-of-life (HRQOL) scores and survival in a heterogeneous cohort of patients with newly diagnosed head and neck squamous cell carcinoma (HNSCC).

Design: Prospective cohort study.

Setting: University hospital and referral center in Western Norway.

Patients: A total of 106 patients with intact cognitive functioning who were younger than 78 years, were diagnosed as having HNSCC, and underwent treatment with curative intent from November 1, 2002, through June 30, 2005.

Main outcome measures: Overall survival and HRQOL scores obtained at the time of diagnosis.

Results: All dichotomized HRQOL sum scores except the functional score (P = .20) were significantly predictive of survival in univariate analyses. The hazard ratios of the dichotomized general symptom, global quality-of-life, and head and neck sum score were 3.66, 0.31, and 2.28, respectively. All sum scores except the dichotomized functional score remained predictive of survival after sequential adjustment for sociodemographic and clinical characteristics, neuroticism, choice of psychological coping, current smoking and alcohol consumption, and comorbidities. Similar findings were found for specific HRQOL indices of physical functioning, dyspnea, sleep disturbance, appetite loss, swallowing, and social eating from the European Organization for Research and Treatment of Cancer 30-Item Core Quality of Life Questionnaire, version 3.0, and the Quality of Life-Head and Neck Cancer Module. Moreover, patients in the highest scoring quartiles for the symptom sum scores and/or the lowest scoring quartile for the global score had overall mortality rates of 50% to 64% compared with 23% to 26% among the other patients.

Conclusion: The HRQOL sum scores and specific indices among HNSCC patients predict survival independently of established known prognostic factors.

MeSH terms

  • Adaptation, Psychological
  • Adult
  • Aged
  • Alcohol Drinking / epidemiology
  • Anxiety Disorders / epidemiology
  • Carcinoma, Squamous Cell / mortality*
  • Carcinoma, Squamous Cell / therapy
  • Comorbidity
  • Female
  • Head and Neck Neoplasms / mortality*
  • Head and Neck Neoplasms / therapy
  • Humans
  • Male
  • Middle Aged
  • Neuroticism
  • Norway / epidemiology
  • Proportional Hazards Models
  • Prospective Studies
  • Quality of Life*
  • Risk Factors
  • Smoking / epidemiology
  • Surveys and Questionnaires
  • Survival Analysis